Boredom is a state of disengagement from your environment and/or whatever activity you happen to be doing. Boredom involves desire in that a person who is bored wants to do something that will fully engage his attention. Unfortunately, the state of boredom renders him unable to identify a sufficiently satisfying activity that will alleviate his condition.
We all experience boredom from time to time. For most of us, it is a transient condition that passes the moment we find something that absorbs our attention. There are some, however, for whom boredom is more pervasive. For whatever reason, these people are consistently unable to find activities that hold their attention. For this reason, many are regular thrill seekers; they spend a considerable amount of time searching for something exciting to relieve their inner monotony. Of course, excitement provides only temporary relief. No matter what they do, the boredom always returns. Thus, they find themselves caught up in a never ending quest for the next thrill.
What causes this condition and what can be done about it? Bernstein attributes chronic boredom to loss of the ability to feel. This occurs, he argues, as a result of early childhood experiences. Specifically, chronic boredom occurs when a child is forced to hold his emotions in before he has developed socially acceptable outlest for discharing the tension these emotions arouse. With no means to express his emotions, he simply learns to repress them. A chaotic, over-stimulating environment will mask his absence of emotion. However, when faced with a less stimulating environment later in life, he begins to notice his lack of emotion. He feels under-stimulated, a condition that manifests itself as boredom.
Kohut likewise attributes chronic boredom to childhood experiences. He ascribes chronic boredom to the consistent failure of parents to be responsive to and to provide stimulation to their child. Consequently, the child comes to crave stimulation and to seek it out in any form.
Many believe that boredom masks an underlying sense of emptiness. According to existential theorists, this emptiness is caused by lacking a purpose or meaning in one's life. (This may or may not be due to childhood experiences). Without a clear purpose, everything seems pointless. If there is no purpose to a particular activity, why do it? For one with no purpose in life, all activities are meaningless.
So what can be done to help the chronically bored? I will suggest a few techniques, but these are by no means exhaustive.
In researching ways to alleviate chronic boredom, I discovered that boredom is more prevalent among people with an external (versus internal) orientation. To be externally oriented is to be habitually focused on the external environment. When an externally oriented person feels bored he attributes it to an under-stimulating environment. Because he sees the external environment as causing his boredom, he looks to the external environment to relieve it. Unfortunately, this strategy is almost always ineffective, at least for the chronically bored.
The conclusion I draw from this information is as follows: if the external environment doesn't hold the answer, perhaps it would help to turn one's attention inward instead. What would happen if sufferers of chronic boredom adopted a curious stance towards their condition? What if they attended to the physical sensations that accompany their boredom and observed how they change over time? I suspect they might begin to see through (or perhaps beneath) the boredom. If nothing else, they'd learn to tolerate the emotion and to simply be with themselves. This alone would go a long way towards quieting their eternal restlessness.
De Chenne suggests that chronically bored people lack knowledge of their emotional and psychological needs. Consequently, he suggests helping the chronically bored to clarify their needs and interests. Once they determine what they need, they are better able to seek out activities that will satisfy and fulfill these needs.
Now for my final suggestion. If everything seems meaningless (and therefore boring), it seems logical that creating, discovering, identifying, or clarifying one's purpose in life would be beneficial. This is admittedly a large task and it might seem too daunting for some. If this is the case, start by simply taking the focus off of self and doing something kind or helpful for someone else.
Sunday, November 4, 2012
Sunday, October 28, 2012
What makes a person boring?
I initially intended to write about the experience of boredom, its potential causes, possible remedies, and the relationship between boredom and suffering. In fact, I still plan to talk about boredom (and chronic boredom in particular), probably as soon as next week. While researching the topic, however, I came across a study about boring people. The study helped to shed some light on why I react certain ways to certain people (including some of my patients). Since the information was helpful to me, I thought it might also be helpful to others.
We probably all know or have known at least one "boring" person. Naturally, we attempt to avoid interacting with this person whenever possible. On those unfortunate occasions when we do have to interact with him or her, we find ourselves struggling to pay attention and yearning to get away. It's human nature: we simply do not like people who bore us.
It is true that what one person finds boring another may find fascinating. Theoretically then, boring is not a trait that is inherent to a particular individual. The individual in question might be boring to one person but rather interesting to another.
And yet, there are certain things that make a person boring to almost everyone, regardless of the circumstances. Leary, Rogers, Canfield, and Coe identified some of these factors in their study, "Boredom in Interpersonal Encounters: Antecedents and Social Implications." The two interpersonal behaviors most associated with being boring were negative egocentrism and banality. The researchers defined negative egocentrism as a behavioral dimension (or category) that includes behaviors such as making frequent negative comments, excessively complaining about personal problems, being self-centered, and showing a lack of interest in others. The authors defined banality as a behavioral dimension encompassing behaviors such as talking only about trivial or superficial subjects, being interested in only one topic, and telling the same stories or jokes over and over again.
Other factors associated with being boring (but to a lesser extent) include "low affectivity" (characterized by low enthusiasm, limited eye contact, low emotional expression, a speaking in monotone) and "tediousness" (characterized by talking slowly, taking a long time to respond, taking a long time to make one's points, adding unneccesarry details, and dragging the conversation on).
The researchers also found that people respond very negatively to boring individuals. Not only do they view them as boring, they also see them as unfriendly and disinterested in others.
This whole thing sort of validates something I've noticed about myself as a therapist. Throughout my career, I've noticed that there are certain patients who just seem to rub me the wrong way. I groan when I see their names on my schedule. In session, I find myself surreptitiously glancing at the clock more often than usual. Every peek at the clock brings despair, as I realize that only a few minutes have passed since I last checked. I breathe a sigh of relief when the session finally ends and they are safely out the door.
Over time, I was able to determine what these patients have in common: they complain about the same problem or set of problems during every session and consistently reject any effort on my part to help them. I now realize that in addition to constantly complaining without trying to change, these patients almost across the board engage in the very behaviors most strongly associated with being boring. They complain excessively about their problems, they are completely focused on themselves and how unhappy they are, and they are disinterested in hearing feedback from me (and probably from anyone else). They show interest in a very limited range of topics, primarily their problems, their symptoms, and their suffering. And they tell the same stories (about their problems) over and over and over again, as if they haven't told them in every other session we've had.
Fortunately, I do not encounter this kind of patient very frequently. I do, however, feel better knowing that my emotional reaction to them is probably quite normal.
We probably all know or have known at least one "boring" person. Naturally, we attempt to avoid interacting with this person whenever possible. On those unfortunate occasions when we do have to interact with him or her, we find ourselves struggling to pay attention and yearning to get away. It's human nature: we simply do not like people who bore us.
It is true that what one person finds boring another may find fascinating. Theoretically then, boring is not a trait that is inherent to a particular individual. The individual in question might be boring to one person but rather interesting to another.
And yet, there are certain things that make a person boring to almost everyone, regardless of the circumstances. Leary, Rogers, Canfield, and Coe identified some of these factors in their study, "Boredom in Interpersonal Encounters: Antecedents and Social Implications." The two interpersonal behaviors most associated with being boring were negative egocentrism and banality. The researchers defined negative egocentrism as a behavioral dimension (or category) that includes behaviors such as making frequent negative comments, excessively complaining about personal problems, being self-centered, and showing a lack of interest in others. The authors defined banality as a behavioral dimension encompassing behaviors such as talking only about trivial or superficial subjects, being interested in only one topic, and telling the same stories or jokes over and over again.
Other factors associated with being boring (but to a lesser extent) include "low affectivity" (characterized by low enthusiasm, limited eye contact, low emotional expression, a speaking in monotone) and "tediousness" (characterized by talking slowly, taking a long time to respond, taking a long time to make one's points, adding unneccesarry details, and dragging the conversation on).
The researchers also found that people respond very negatively to boring individuals. Not only do they view them as boring, they also see them as unfriendly and disinterested in others.
This whole thing sort of validates something I've noticed about myself as a therapist. Throughout my career, I've noticed that there are certain patients who just seem to rub me the wrong way. I groan when I see their names on my schedule. In session, I find myself surreptitiously glancing at the clock more often than usual. Every peek at the clock brings despair, as I realize that only a few minutes have passed since I last checked. I breathe a sigh of relief when the session finally ends and they are safely out the door.
Over time, I was able to determine what these patients have in common: they complain about the same problem or set of problems during every session and consistently reject any effort on my part to help them. I now realize that in addition to constantly complaining without trying to change, these patients almost across the board engage in the very behaviors most strongly associated with being boring. They complain excessively about their problems, they are completely focused on themselves and how unhappy they are, and they are disinterested in hearing feedback from me (and probably from anyone else). They show interest in a very limited range of topics, primarily their problems, their symptoms, and their suffering. And they tell the same stories (about their problems) over and over and over again, as if they haven't told them in every other session we've had.
Fortunately, I do not encounter this kind of patient very frequently. I do, however, feel better knowing that my emotional reaction to them is probably quite normal.
Sunday, October 21, 2012
Becoming disillusioned
As young adults, I think most of us start out with a certain number of illusions. We have ideas about the world and our place in it. Those with the most ambition seem to have the most illusions. Many intelligent, talented emerging adults have been praised and lauded throughout their lives for their talents and abilities. They are told they can do or be anything if they apply themselves diligently.
And so they graduate high school and set off to take on the world with a head full of dreams. Most are optimistic about their futures. If asked, they would probably say that they have an important contribution to make to the world, that they are destined for greatness, or that they are going to do big things.
After spending some time in the "real world," many of these once hopeful young adults enter a period of disillusionment. They may encounter a world that is not receptive to the kind of big changes they'd envisioned themselves making. Their power (and thus their ability to enact change) may be limited by virtue of their youth and inexperience. They may lack the resources, the venue, or the support to achieve the great things they were once certain they would accomplish. Or they may find the demands of adulthood consume all their time and energy, leaving precious little to devote to pursuing their dreams.
For me, disillusionment came soon after I started my first job after college. Looking back, I can't even recall what I hoped to do with my life. I just know I envisioned myself making a big impact on the lives of a lot of people. I had a lot of ideas that I initially pursued with vigor. Soon after college, I begn completing the requirements for certification in biofeedback. I proposed a research project at my place of employment and got the go-ahead from my boss to start doing the background literature review. I started working towards formal licensure as a clinical social worker in the state of Virginia. I did a project on the side for a woman who ran a small non-profit focused on suicide prevention.
And then I hit a brick wall. I had to put the biofeedback certification process on hold because I couldn't afford to pay for the supervision. I finished my literature review and reported my findings. I was told there was no way to implement the study because it would require (at minimum) one additional staff member and the organization wasn't going to pay for that. (That didn't stop them from going out to other organizations and telling them we were offering the program, even though we weren't). The person providing supervision for Virginia licensure told me she was too busy and couldn't do it anymore. The non-profit lady used my work for her presentation; I never heard from her again after that.
There were other things too, but you get the point. I was depressed. I grew cynical. I hated my job. I decided I'd chosen the wrong career field. I was completely disillusioned.
In the end I found my peace. In the process, I discovered a lot about myself. I also grew up. I learned how to function in the world as it is, not how I want it to be. It was difficult, but I think it was also necessary. Before you can cope with reality you have to accept it as it is, even if you don't necessarily like it.
And so they graduate high school and set off to take on the world with a head full of dreams. Most are optimistic about their futures. If asked, they would probably say that they have an important contribution to make to the world, that they are destined for greatness, or that they are going to do big things.
After spending some time in the "real world," many of these once hopeful young adults enter a period of disillusionment. They may encounter a world that is not receptive to the kind of big changes they'd envisioned themselves making. Their power (and thus their ability to enact change) may be limited by virtue of their youth and inexperience. They may lack the resources, the venue, or the support to achieve the great things they were once certain they would accomplish. Or they may find the demands of adulthood consume all their time and energy, leaving precious little to devote to pursuing their dreams.
For me, disillusionment came soon after I started my first job after college. Looking back, I can't even recall what I hoped to do with my life. I just know I envisioned myself making a big impact on the lives of a lot of people. I had a lot of ideas that I initially pursued with vigor. Soon after college, I begn completing the requirements for certification in biofeedback. I proposed a research project at my place of employment and got the go-ahead from my boss to start doing the background literature review. I started working towards formal licensure as a clinical social worker in the state of Virginia. I did a project on the side for a woman who ran a small non-profit focused on suicide prevention.
And then I hit a brick wall. I had to put the biofeedback certification process on hold because I couldn't afford to pay for the supervision. I finished my literature review and reported my findings. I was told there was no way to implement the study because it would require (at minimum) one additional staff member and the organization wasn't going to pay for that. (That didn't stop them from going out to other organizations and telling them we were offering the program, even though we weren't). The person providing supervision for Virginia licensure told me she was too busy and couldn't do it anymore. The non-profit lady used my work for her presentation; I never heard from her again after that.
There were other things too, but you get the point. I was depressed. I grew cynical. I hated my job. I decided I'd chosen the wrong career field. I was completely disillusioned.
In the end I found my peace. In the process, I discovered a lot about myself. I also grew up. I learned how to function in the world as it is, not how I want it to be. It was difficult, but I think it was also necessary. Before you can cope with reality you have to accept it as it is, even if you don't necessarily like it.
Sunday, October 14, 2012
Living without pleasure
People tend to think of depression as a syndrome characterized primarily by pervasive feelings of sadness. To be depressed is to be in such despair that it becomes difficult to function. Many of us have either known someone struggling with depression or have seen it somehow depicted by cultural media. As a result, few of us are completely unfamiliar with what it means to be depressed.
Many of my patients struggle with depression. For every new patient seen in our clinic, we obtain a full biopsychosocial history and perform a complete diagnostic assessment. Ideally, the goal of this assessment is to generate an overview of the patient's "problem," preferably in the form of a clinical diagnosis. In reality, however, I find that few patients really need me to tell them what's wrong; most of them already have an idea of what's wrong, which is the reason they've sought help in the first place. In other words, a person struggling with depression already knows he feels depressed; he gains very little from having me slap a label on it.
From time to time, however, I encounter patients who seem clearly depressed to me but who are quite surprised to hear me say it. "I don't feel depressed," they say. You see, depression doesn't always look the way we think it does. In fact, it's quite possible for someone who doesn't necessarily feel depressed to meet the diagnostic criteria for Major Depressive Disorder. Rather than feeling depressed, the problem for such a person might be that he doesn't feel much of anything at all.
Anhedonia has been described, quite poetically, as the "paralysis of emotion." It comes from a combination of the Greek a + hedone, literally meaning "not pleasure." In mental health, it refers to an inability to experience pleasure in activities that one would typically find enjoyable.
Patients relate how they experience it. "I just feel 'blah," is a quite common description. Others talk about lacking motivation. "I don't feel like doing anything," they say. "I can't get motivated." Still others become distressed by what they perceive as a personal failing. "I don't even enjoy spending time with my kids. The whole time I'm with them I'm looking at my watch, wanting it to be over;" or perhaps, "I know I love my kids, but I just can't feel it."
I wish I could conclude my little presentation with some wisdom about how we can all learn to experience pleasure in life. The truth is, I let out an inward groan everytime a patient tells me he is unable to find pleasure in anything. That's because as a symptom, anhedonia is notoriously difficult to treat. As a therapist, I can encourage you to engage in activities that should theoretically be enjoyable, but I can't make you enjoy them. I'm not even sure I can teach you to enjoy them. How do you teach something like that? Treatment with antidepressant medications have very limited success as well. It's a situation that often makes me feel helpless.
But if I feel helpless, imagine how the patient must feel. Imagine a life without pleasure. What kind of life would that be?
Many of my patients struggle with depression. For every new patient seen in our clinic, we obtain a full biopsychosocial history and perform a complete diagnostic assessment. Ideally, the goal of this assessment is to generate an overview of the patient's "problem," preferably in the form of a clinical diagnosis. In reality, however, I find that few patients really need me to tell them what's wrong; most of them already have an idea of what's wrong, which is the reason they've sought help in the first place. In other words, a person struggling with depression already knows he feels depressed; he gains very little from having me slap a label on it.
From time to time, however, I encounter patients who seem clearly depressed to me but who are quite surprised to hear me say it. "I don't feel depressed," they say. You see, depression doesn't always look the way we think it does. In fact, it's quite possible for someone who doesn't necessarily feel depressed to meet the diagnostic criteria for Major Depressive Disorder. Rather than feeling depressed, the problem for such a person might be that he doesn't feel much of anything at all.
Anhedonia has been described, quite poetically, as the "paralysis of emotion." It comes from a combination of the Greek a + hedone, literally meaning "not pleasure." In mental health, it refers to an inability to experience pleasure in activities that one would typically find enjoyable.
Patients relate how they experience it. "I just feel 'blah," is a quite common description. Others talk about lacking motivation. "I don't feel like doing anything," they say. "I can't get motivated." Still others become distressed by what they perceive as a personal failing. "I don't even enjoy spending time with my kids. The whole time I'm with them I'm looking at my watch, wanting it to be over;" or perhaps, "I know I love my kids, but I just can't feel it."
I wish I could conclude my little presentation with some wisdom about how we can all learn to experience pleasure in life. The truth is, I let out an inward groan everytime a patient tells me he is unable to find pleasure in anything. That's because as a symptom, anhedonia is notoriously difficult to treat. As a therapist, I can encourage you to engage in activities that should theoretically be enjoyable, but I can't make you enjoy them. I'm not even sure I can teach you to enjoy them. How do you teach something like that? Treatment with antidepressant medications have very limited success as well. It's a situation that often makes me feel helpless.
But if I feel helpless, imagine how the patient must feel. Imagine a life without pleasure. What kind of life would that be?
Sunday, October 7, 2012
Things that don't come naturally
My sister-in-law has a very gentle quality about her and a very sweet demeanor. She's also very physically affectionate, at least with her family. Whenever she's around my stepdaughter (and even when she's around my two nieces), it's like no one else exists. When my sister-in-law enters the room, the kids fight over who gets to sit next to her. I watch them together - especially her and my stepdaughter - and I can't help but feel a little envious. My sister-in-law heaps on hugs, kisses, and tickles and the kids eat it up. "Why can't I be more like her?" I often wonder.
During a family vacation this summer, I noticed that my sister and her husband are always holding hands, putting their arms around one another, or sharing a quick kiss. More often than not, the two of them occupied only one chair, even if that meant one of them sitting on the other's lap. I mentioned to my husband that I was a bit jealous of how affectionate the they are with each other. "Why aren't we more like that?" I asked him.
I knew what he was going to say before he said it. It's me. I know it's me. I don't have a problem with nor am I averse to physical affection - or even public displays of affection - it's just that it doesn't come "natural" to me. In fact, it's not even physical affection per se that doesn't come naturally. Almost without fail I give hugs and kisses to family and friends at every hello, goodbye, and goodnight. And any kid that hops in my lap is always perfectly welcome there. I'm just not the type of person who instinctively reaches for an embrace or a hand to hold whenever I find myself in the presence of others. That kind of affection is something that requires a conscious effort on my part. It's something I have to actually think about and remind myself to do.
I don't know why I'm not naturally drawn towards physical contact. I certainly wish I were different in this regard. I suspect that we all have our strengths and weaknesses. Some things come naturally to certain people and some things don't. I've never met a person to whom everything comes naturally. We all struggle with something.
What I do know is that just becomes something is difficult doesn't mean I can't learn to do it. I have some experience with this. I do really well with verbal and written academic work; I have always struggled with math. I have vivid memories of sobbing over Algebra homework in the eighth grade. As an adult, I needed to complete two math classes for my college degree. I took the first class one summer and the second one the next. This allowed me to focus exclusively on math without worrying about other subjects. After each class, I went to the math lab, did my homework, and had the tutor check my answers. He then went over the problems I got wrong. I sometimes spent hours on homework before I fully understood it. Whenever we had a test, I was always the last person finished; I also earned the highest final grade in both classes. I still struggle with math, but now I know I can do it; I just have to put more effort into it than other people.
I've had similar experiences with art -- I have absolutely NO natural depth perception nor any sense of proportions or spatial positioning. Yet I have, on occasion, come out with a decent drawing or painting (always after a few false starts, of course).
The point is, this whole physical affection thing is something I can learn, even if it doesn't come naturally. What I need more than anything is patience - both from myself and from others.
Is there anything you've learned to do that didn't come naturally? Was it frustrating? Do you still struggle with it? I'd love to hear your story!
During a family vacation this summer, I noticed that my sister and her husband are always holding hands, putting their arms around one another, or sharing a quick kiss. More often than not, the two of them occupied only one chair, even if that meant one of them sitting on the other's lap. I mentioned to my husband that I was a bit jealous of how affectionate the they are with each other. "Why aren't we more like that?" I asked him.
I knew what he was going to say before he said it. It's me. I know it's me. I don't have a problem with nor am I averse to physical affection - or even public displays of affection - it's just that it doesn't come "natural" to me. In fact, it's not even physical affection per se that doesn't come naturally. Almost without fail I give hugs and kisses to family and friends at every hello, goodbye, and goodnight. And any kid that hops in my lap is always perfectly welcome there. I'm just not the type of person who instinctively reaches for an embrace or a hand to hold whenever I find myself in the presence of others. That kind of affection is something that requires a conscious effort on my part. It's something I have to actually think about and remind myself to do.
I don't know why I'm not naturally drawn towards physical contact. I certainly wish I were different in this regard. I suspect that we all have our strengths and weaknesses. Some things come naturally to certain people and some things don't. I've never met a person to whom everything comes naturally. We all struggle with something.
What I do know is that just becomes something is difficult doesn't mean I can't learn to do it. I have some experience with this. I do really well with verbal and written academic work; I have always struggled with math. I have vivid memories of sobbing over Algebra homework in the eighth grade. As an adult, I needed to complete two math classes for my college degree. I took the first class one summer and the second one the next. This allowed me to focus exclusively on math without worrying about other subjects. After each class, I went to the math lab, did my homework, and had the tutor check my answers. He then went over the problems I got wrong. I sometimes spent hours on homework before I fully understood it. Whenever we had a test, I was always the last person finished; I also earned the highest final grade in both classes. I still struggle with math, but now I know I can do it; I just have to put more effort into it than other people.
I've had similar experiences with art -- I have absolutely NO natural depth perception nor any sense of proportions or spatial positioning. Yet I have, on occasion, come out with a decent drawing or painting (always after a few false starts, of course).
The point is, this whole physical affection thing is something I can learn, even if it doesn't come naturally. What I need more than anything is patience - both from myself and from others.
Is there anything you've learned to do that didn't come naturally? Was it frustrating? Do you still struggle with it? I'd love to hear your story!
Sunday, September 30, 2012
Not everything is pathological!
Not everything is pathological! Some of my patients need to be told this repeatedly. Every session brings a new complaint. "I had trouble falling a sleep a couple of times last week," one might say. "I had a nightmare a few weeks ago," another tells me. "I was really tired on Monday," says another. Sometimes I recall my own recent experiences and think to myself, "Yeah, I remember feeling tired at least once last week; probably more than once. And I'm sure there was at least one night when I had trouble sleeping. It wasn't a big deal."
Not only are these experiences "not a big deal," they're completely normal. Who among us doesn't have trouble sleeping from time to time, particularly when we're worried about something? Who doesn't wake up feeling irritable on occasion? Who doesn't have a hard time finding motivation to clean the house or run some errands every once in a while?
At some point we all have these experiences, yet rarely do we become alarmed by them. Why is it, then, that a substantial minority of my patients find such things concerning enough to bring to my attention? (At least I assume that's why they share these concerns, since we're there to talk about problems that require treatment).
When such conerns are raised in session, the first thing I do is to normalize my patient's experience. I try to explain that not every unpleasant experience is a sign of a larger problem. In life, I tell them, we all deal with feelings we'd rather not have, events we wish wouldn't happen, and physical aches and pains we'd prefer not to endure. Such things even occur sometimes without any identifiable reason. It's important, I explain, to remember that something doesn't have to be problematic just because it's unpleasant. In fact, labeling something as problematic probably only makes it more unpleasant.
After normalizing, I attempt to help the patient clarify what constitutes a problem and what doesn't. (While it's not beneficial to classify every negative experience as problematic, neither is it wise to ignore negative experiences that really are problematic).
So how do we know when something is a problem and when it's just a variation of normal human experience? When trying to define a somewhat abstract concept, I like to start by consulting a dictionary for a more literal definition. There are several entries in a standard English dictionary under the word problem. One entry defines the word problem as "something that causes trouble or difficulty." Thus, a problem is something that causes difficulty by interfering with your daily functioning or by significantly decreasing your quality of life. Can you still go to work, pay your bills, or otherwise fulfill your normal daily responsibilities? Can you still experience pleasure and enjoyment? Can you maintain at least a few functioning interpersonal relationships? If so, you're probably doing okay.
Problem is also defined as "an undesirable condition that needs to be corrected." The key word here is condition. A condition is a mode of being or form of existence. It permeates all aspects of one's life, implying that it exists over a period of time. Thus, a problem is unlikely to be something that happens just once or even rarely. Typically, a problem is something that is present over a period of time and in a variety of situations. (To diagnose a mental illness, the field of mental health requires a set of symptoms to be present for specific minimum periods of time).
Yet another way to define problem is as "something that is difficult to manage." The implication here is that a problem is something that challenges one's ability to cope. Those with an average set of coping skills are able to cope with minor annoyances and irritations quite easily. Something becomes a problem only when a person's usual coping mechanisms aren't effective in dealing with it and the person becomes overwhelmed.
I'm sure I've missed some things and of course, there are exceptions to every rule. The main point is just that not everything unpleasant is a problem and that labeling it a problem only makes it more unpleasant.
Not only are these experiences "not a big deal," they're completely normal. Who among us doesn't have trouble sleeping from time to time, particularly when we're worried about something? Who doesn't wake up feeling irritable on occasion? Who doesn't have a hard time finding motivation to clean the house or run some errands every once in a while?
At some point we all have these experiences, yet rarely do we become alarmed by them. Why is it, then, that a substantial minority of my patients find such things concerning enough to bring to my attention? (At least I assume that's why they share these concerns, since we're there to talk about problems that require treatment).
When such conerns are raised in session, the first thing I do is to normalize my patient's experience. I try to explain that not every unpleasant experience is a sign of a larger problem. In life, I tell them, we all deal with feelings we'd rather not have, events we wish wouldn't happen, and physical aches and pains we'd prefer not to endure. Such things even occur sometimes without any identifiable reason. It's important, I explain, to remember that something doesn't have to be problematic just because it's unpleasant. In fact, labeling something as problematic probably only makes it more unpleasant.
After normalizing, I attempt to help the patient clarify what constitutes a problem and what doesn't. (While it's not beneficial to classify every negative experience as problematic, neither is it wise to ignore negative experiences that really are problematic).
So how do we know when something is a problem and when it's just a variation of normal human experience? When trying to define a somewhat abstract concept, I like to start by consulting a dictionary for a more literal definition. There are several entries in a standard English dictionary under the word problem. One entry defines the word problem as "something that causes trouble or difficulty." Thus, a problem is something that causes difficulty by interfering with your daily functioning or by significantly decreasing your quality of life. Can you still go to work, pay your bills, or otherwise fulfill your normal daily responsibilities? Can you still experience pleasure and enjoyment? Can you maintain at least a few functioning interpersonal relationships? If so, you're probably doing okay.
Problem is also defined as "an undesirable condition that needs to be corrected." The key word here is condition. A condition is a mode of being or form of existence. It permeates all aspects of one's life, implying that it exists over a period of time. Thus, a problem is unlikely to be something that happens just once or even rarely. Typically, a problem is something that is present over a period of time and in a variety of situations. (To diagnose a mental illness, the field of mental health requires a set of symptoms to be present for specific minimum periods of time).
Yet another way to define problem is as "something that is difficult to manage." The implication here is that a problem is something that challenges one's ability to cope. Those with an average set of coping skills are able to cope with minor annoyances and irritations quite easily. Something becomes a problem only when a person's usual coping mechanisms aren't effective in dealing with it and the person becomes overwhelmed.
I'm sure I've missed some things and of course, there are exceptions to every rule. The main point is just that not everything unpleasant is a problem and that labeling it a problem only makes it more unpleasant.
Sunday, September 23, 2012
Suppressing Emotions
There are people who believe emotions are unnecessary and so seek to distance themselves from their emotional experiences. There's certainly nothing wrong with gaining some distance from our emotions. In fact, it's a skill we need if we want to function "normally" in society. Distancing ourselves from our emotions is only problematic when it becomes our primary method of responding to our feelings. The eventual result of suppressing every strong emotion that arises is emotional detachment. To be emotionally detached is to no longer recognize the physiological changes that accompany each emotion. These changes continue to occur, they just do so outside of conscious awareness.
At its core, emotional detachment is nothing more than the absence of self awareness. There are, of course, some who say that ignorance is bliss; you cannot feel pain if you cannot (or do not allow yourself to) feel. In my opinion, a life devoid of emotion is an empty life indeed. I cannot imagine living a life without happiness or a life without love. It is difficult to think one could find meaning in such a life. And yet, there are those who choose this path; they give up the pursuit of happiness in an effort to avoid pain.
It doesn't work. In reality, refusing to engage with our emotions has consequences that go beyond missing out on the richness of emotional experience. It turns out that actively suppressing emotions impacts our physical health as well. Several studies have shown that suppressing emotions (both negative and positive) leads to increased sympathetic activation of the cardiovascular system. When the cardiovascular system is hyper-activated repeatedly over an extended period of time, "such...activation might lead to chronic functional and structural changes of the cardiovascular system that compromise its performance" (Mauss and Gross, from Chapter 4 of "Emotional Epxression and Health: Advances in theory, assessment, and clinical applications," 2004). Related health problems include hypertension and atherosclerosis, both of which lead to an increased risk of heart attack and "sudden cardiac death."
Simply stated, chornic emotional suppression is bad for your heart. Or, as I frequently caution my patients: "If you don't deal with your emotions then your emotions will deal with you."
At its core, emotional detachment is nothing more than the absence of self awareness. There are, of course, some who say that ignorance is bliss; you cannot feel pain if you cannot (or do not allow yourself to) feel. In my opinion, a life devoid of emotion is an empty life indeed. I cannot imagine living a life without happiness or a life without love. It is difficult to think one could find meaning in such a life. And yet, there are those who choose this path; they give up the pursuit of happiness in an effort to avoid pain.
It doesn't work. In reality, refusing to engage with our emotions has consequences that go beyond missing out on the richness of emotional experience. It turns out that actively suppressing emotions impacts our physical health as well. Several studies have shown that suppressing emotions (both negative and positive) leads to increased sympathetic activation of the cardiovascular system. When the cardiovascular system is hyper-activated repeatedly over an extended period of time, "such...activation might lead to chronic functional and structural changes of the cardiovascular system that compromise its performance" (Mauss and Gross, from Chapter 4 of "Emotional Epxression and Health: Advances in theory, assessment, and clinical applications," 2004). Related health problems include hypertension and atherosclerosis, both of which lead to an increased risk of heart attack and "sudden cardiac death."
Simply stated, chornic emotional suppression is bad for your heart. Or, as I frequently caution my patients: "If you don't deal with your emotions then your emotions will deal with you."
Sunday, September 16, 2012
Hearing others' stories
Over the years, I've discovered that my patients appreciate consistency. They like knowing what to expect when they come to see me. I've noticed that even significant changes to my appearance can be unsettling for some.
I get it. People come to therapy when the problems they're dealing with become overwhelming. Often, their entire world seems unpredictable and chaotic. Therapy becomes a sort of haven of stability where they can try to sort things out. The consistency is comforting and provides a sense of safety.
This works for me. I too have a deep appreciation for stability. When I do make changes, it is almost always incrementally. I like knowing that even if I can't fix a patient's problems, I can at least give him somewhere to feel safe and accepted.
The first and sometimes only service I provide in this role is to bear witness to a patient's story. I listen and I validate. I did not initially realize how important this is. After all, anybody can listen, right? Apparently not. The mission of the clinic I work in is to provide interventions to those who have had one or more traumatic experiences. A lot of the patients I see have never shared their stories with anyone. Having the opportunity to talk about what they've been through is often quite powerful.
So imagine if I were to interrupt their narrative and say, "Stop. It's too horrible. I don't want to hear anymore!" It would confirm what they've long suspected: their suffering is theirs to bear, alone. No one can help them.
All of us at the clinic are aware of the risk for "vicarious traumatization" - being traumatized by someone else's trauma. I've been lucky; for the most part, patients' stories don't bother me. Of course I feel bad that they've gone through such terrible things, but hearing about it doesn't unnerve me; I maintain the same steady, reliable presence that my patients have come to expect from me. For me, tt's almost like when a patient leaves my office he takes his story with him. I don't hold onto it and I don't really think about it until the patient's next visit.
Something different happened this week. It was my first session with this particular patient. She'd seen one of the psychiatrists and was referred to me for therapy. I wanted to take the initial session to get to know her and to get an understanding of the problems she's dealing with. About halfway through the session, I asked if she felt comfortable giving a brief summary of her traumatic experiences.
My patient began sharing her story. I interjected a few times to ask questions for clarification. Mostly, I listened. Everything was fine until the patient reached a point in her story that involved being conscious for a medical procedure in which she lost massive amounts of blood.
I started becoming dizzy. Suddenly I felt hot and I began sweating profusely. (It was literally dripping off of me; when it was all said and done, I noticed that my clothes were wet). I was lighthead and the room looked like it was spinning. My patient was still talking but she sounded far away, or maybe muffled.
It occured to me that I've experienced this sort of thing before. You see, I have a strong aversion to needles. For years I used to faint everytime I had to give blood. Eventually, I discovered that I could prevent myself from passing out if I took deep breaths during the procedure and avoided looking at the needle or the blood. Still, even now I get anxious whenever I'm faced with the prospect of getting stuck with a needle.
So here I am in session with a patient and I think I might pass out from hearing her story. I didn't want to ask her to stop -- what kind of message would that send? On the other hand, how would she feel if I passed out right there? To make matters worse, the room was still spinning and I couldn't think clearly.
Finally, I lifted my hand and said, "Hold on a minute." I tried to recompose myself but it was so hot and I felt so lightheaded.
"Was it the blood?" my patient asked.
"Yeah," I said. "Just give me a minute. I am so sorry."
Eventually, I excused myself. A coworker's door was open and I slipped into her office. "Are you okay?" she asked, alarmed. "Your face is green! Why are you all wet? What's wrong?"
Fortunately, the temperature in my coworker's office was much cooler than that of my own. The blast of cool air did the trick. Within a few minutes, I was feeling better. I ended up going back to talk to the patient. I apologized and told her we'd meet again next week (if she still wanted to, of course).
I felt like I needed to share this because I didn't want to allow myself to become embarrassed (anymore than I was at the time) about it. In my opinion, the sooner I can look back on something and laugh, the better. I've also been mentally rehearsing my patient's story so that I'm ready to hear it when the time comes for her to tell it again.
I get it. People come to therapy when the problems they're dealing with become overwhelming. Often, their entire world seems unpredictable and chaotic. Therapy becomes a sort of haven of stability where they can try to sort things out. The consistency is comforting and provides a sense of safety.
This works for me. I too have a deep appreciation for stability. When I do make changes, it is almost always incrementally. I like knowing that even if I can't fix a patient's problems, I can at least give him somewhere to feel safe and accepted.
The first and sometimes only service I provide in this role is to bear witness to a patient's story. I listen and I validate. I did not initially realize how important this is. After all, anybody can listen, right? Apparently not. The mission of the clinic I work in is to provide interventions to those who have had one or more traumatic experiences. A lot of the patients I see have never shared their stories with anyone. Having the opportunity to talk about what they've been through is often quite powerful.
So imagine if I were to interrupt their narrative and say, "Stop. It's too horrible. I don't want to hear anymore!" It would confirm what they've long suspected: their suffering is theirs to bear, alone. No one can help them.
All of us at the clinic are aware of the risk for "vicarious traumatization" - being traumatized by someone else's trauma. I've been lucky; for the most part, patients' stories don't bother me. Of course I feel bad that they've gone through such terrible things, but hearing about it doesn't unnerve me; I maintain the same steady, reliable presence that my patients have come to expect from me. For me, tt's almost like when a patient leaves my office he takes his story with him. I don't hold onto it and I don't really think about it until the patient's next visit.
Something different happened this week. It was my first session with this particular patient. She'd seen one of the psychiatrists and was referred to me for therapy. I wanted to take the initial session to get to know her and to get an understanding of the problems she's dealing with. About halfway through the session, I asked if she felt comfortable giving a brief summary of her traumatic experiences.
My patient began sharing her story. I interjected a few times to ask questions for clarification. Mostly, I listened. Everything was fine until the patient reached a point in her story that involved being conscious for a medical procedure in which she lost massive amounts of blood.
I started becoming dizzy. Suddenly I felt hot and I began sweating profusely. (It was literally dripping off of me; when it was all said and done, I noticed that my clothes were wet). I was lighthead and the room looked like it was spinning. My patient was still talking but she sounded far away, or maybe muffled.
It occured to me that I've experienced this sort of thing before. You see, I have a strong aversion to needles. For years I used to faint everytime I had to give blood. Eventually, I discovered that I could prevent myself from passing out if I took deep breaths during the procedure and avoided looking at the needle or the blood. Still, even now I get anxious whenever I'm faced with the prospect of getting stuck with a needle.
So here I am in session with a patient and I think I might pass out from hearing her story. I didn't want to ask her to stop -- what kind of message would that send? On the other hand, how would she feel if I passed out right there? To make matters worse, the room was still spinning and I couldn't think clearly.
Finally, I lifted my hand and said, "Hold on a minute." I tried to recompose myself but it was so hot and I felt so lightheaded.
"Was it the blood?" my patient asked.
"Yeah," I said. "Just give me a minute. I am so sorry."
Eventually, I excused myself. A coworker's door was open and I slipped into her office. "Are you okay?" she asked, alarmed. "Your face is green! Why are you all wet? What's wrong?"
Fortunately, the temperature in my coworker's office was much cooler than that of my own. The blast of cool air did the trick. Within a few minutes, I was feeling better. I ended up going back to talk to the patient. I apologized and told her we'd meet again next week (if she still wanted to, of course).
I felt like I needed to share this because I didn't want to allow myself to become embarrassed (anymore than I was at the time) about it. In my opinion, the sooner I can look back on something and laugh, the better. I've also been mentally rehearsing my patient's story so that I'm ready to hear it when the time comes for her to tell it again.
Sunday, September 9, 2012
Regret
It is impossible to go through life without ever experiencing regret, even when we intentionally avoid doing things we'll later wish we hadn't (or intentionally seek to do things we know we'll regret not doing). We are human; we make mistakes. Our mistakes beget unpleasant outcomes. In the midst of coping with the consequences of our bad decisions, it is only natural to wish we'd made different choices. This is regret: to feel a sense of personal responsibility for the way things turned out and to imagine that things would be better if we'd only decided differently.
Regret is a natural consequence of being free to make choices. Studies have shown that the very act of choosing almost immediately leads to regret and causes the unchosen option or options to appear more attractive. Because there is regret associated with each unchosen option, more options leads to more regret. Researchers have found that we anticipate this regret and take it into account everytime we make a decision. When tasked with choosing from a large number of options, the amount of regret we anticipate can seem a bit daunting. This is consistent with evidence suggesting that the more options we have, the less likely we are to make any choice.
Of course, deciding not to choose is also a choice. We opt out of making a decision so we won't have to face the regret associated with the options we did not select. And so we are spared, at least in the short term. We have not, however, successfully avoided our regret; we've merely postponed it. Here I borrow a quote from Gilovich and Medvec: "As troubling as regrettable actions might be initially, when people look back on their lives, it seems to be their regrettable failures to act that stand out and cause greater grief."
The research gives some credence to my own personal decision-making philosophy. (Not that the "philosophy" itself was developed with this in mind. Still, it's nice when there's actual evidence to support the quirky way I do things). When faced with multiple options, I gather a small amount of basic information about each of them. (Notice the emphasis on small and basic). This allows me to rule out any options that clearly aren't a good fit. At that point, I am typically left with several equally attractive alternatives.
The way I see it, if all options are equally attractive then it really doesn't matter which one I choose. It's unlikely that gathering more information will help. You see, the more I learn about each option, the more attractive they will all seem. This will make it more difficult for me to choose one over the others. So I just pick one. It doesn't matter how; maybe I'll write them all down on little slips of paper, put them in a bowl, mix them up, and pull one out. Maybe I'll cut out pictures of them, lay them out in a circle around me, close my eyes, spin around, come to a stop, and point. Whatever. I just pick one. And once I've made my choice, I fully commit to it. I don't second guess myself. I don't keep looking for other possible options "just to see" if I could've gotten a better deal. I make my selection and commit to it; then I move on.
Have I managed to eliminate all traces of regret from my life? Um, no. I'm human, after all. Like everyone else, I'm a work in progress...
Regret is a natural consequence of being free to make choices. Studies have shown that the very act of choosing almost immediately leads to regret and causes the unchosen option or options to appear more attractive. Because there is regret associated with each unchosen option, more options leads to more regret. Researchers have found that we anticipate this regret and take it into account everytime we make a decision. When tasked with choosing from a large number of options, the amount of regret we anticipate can seem a bit daunting. This is consistent with evidence suggesting that the more options we have, the less likely we are to make any choice.
Of course, deciding not to choose is also a choice. We opt out of making a decision so we won't have to face the regret associated with the options we did not select. And so we are spared, at least in the short term. We have not, however, successfully avoided our regret; we've merely postponed it. Here I borrow a quote from Gilovich and Medvec: "As troubling as regrettable actions might be initially, when people look back on their lives, it seems to be their regrettable failures to act that stand out and cause greater grief."
The research gives some credence to my own personal decision-making philosophy. (Not that the "philosophy" itself was developed with this in mind. Still, it's nice when there's actual evidence to support the quirky way I do things). When faced with multiple options, I gather a small amount of basic information about each of them. (Notice the emphasis on small and basic). This allows me to rule out any options that clearly aren't a good fit. At that point, I am typically left with several equally attractive alternatives.
The way I see it, if all options are equally attractive then it really doesn't matter which one I choose. It's unlikely that gathering more information will help. You see, the more I learn about each option, the more attractive they will all seem. This will make it more difficult for me to choose one over the others. So I just pick one. It doesn't matter how; maybe I'll write them all down on little slips of paper, put them in a bowl, mix them up, and pull one out. Maybe I'll cut out pictures of them, lay them out in a circle around me, close my eyes, spin around, come to a stop, and point. Whatever. I just pick one. And once I've made my choice, I fully commit to it. I don't second guess myself. I don't keep looking for other possible options "just to see" if I could've gotten a better deal. I make my selection and commit to it; then I move on.
Have I managed to eliminate all traces of regret from my life? Um, no. I'm human, after all. Like everyone else, I'm a work in progress...
Sunday, September 2, 2012
On being an introvert
Sometimes it's hard being an introvert. It seems like extroverts have all the advantages, at least in today's world. American society values the characteristics associated with extroversion: energetic, outgoing, enthusiastic, active, willing to take risks, objective, cheerful, expressive. Extroverts are quick to engage with others. Because they tend to be action-oriented, they enlist other people in doing things; this shared participation in a common activity provides the context for building interpersonal connections. Thus, extroverts establish relationships quickly and easily. People like extroverts and they like to be around them.
Whereas the extrovert is attuned to and energized by the external environment, introverts tend to focus their attention inward. Introverts spend a lot of time thinking, interpreting, and analyzing. They often enjoy abstract concepts and ideas. They typically concentrate well and are not easily distracted. The extrovert gains energy by spending time with others; the introvert gains energy by spending time alone. Thus, introverts often withdraw from social situations.
These are not the qualities that get a person noticed. They are not the characteristics Americans tend to associate with success. Americans admire and respect the type of people who can walk into a situation and take charge without batting an eyelash. They look up to people who appear steady and confident. In America, the qualities of the extrovert are seen as favorable and are therefore advantageous.
In addition, there is an abundant body of evidence suggesting that extroverts tend to be significantly happier than introverts. So many studies, in fact, have demonstrated this effect that Lucas, Le, and Dyrenforth call the correlation between extroversion and positive emotion "one of the most robust findings in the study of personality and emotion." There have even been studies showing that introverts can increase their positive emotion by acting like extroverts.
And so being an introvert can be difficult. We're systematically undervalued and frequently misunderstood. Often, we're encouraged to become more extroverted, implying that there's something wrong with the way we are. I've seen the impact this can have on people. Over the years, I've had many introverted patients who came to me thinking there was something wrong with them. Such is the plight of the introvert living in an extrovert's world.
I briefly saw a psychologist when I was in graduate school. One of the first things he did was have me complete the Myers-Briggs (a personality assessment). I remember when we went over the results together. "So do you think you're an introvert or an extrovert?" he asked before revealing what the assessment showed. "I don't know," I replied. "I could see it going either way." "Actually," he said, pausing. "You're pretty strongly introverted." "Really?" I asked, surprised. I'd always thought of introverts as being shy, reserved, and quiet -- all things I definately am not. (As it turns out, this is a common misconception).
Discovering I'm an introvert shed new light on a light of things I didn't understand about myself. Once I understood these things about myself I was able to embrace them. I was also more sensitive to what I needed -- plenty of alone time to think and reflect as well as quiet time to regroup after socializing. Whenever I have a patient who is clearly introverted, I set aside time to help them understand what this means. I normalize their need for alone time; I explain that making time to be alone is an essential part of taking care of themselves. Hopefully, they will learn to embrace who they are...
Whereas the extrovert is attuned to and energized by the external environment, introverts tend to focus their attention inward. Introverts spend a lot of time thinking, interpreting, and analyzing. They often enjoy abstract concepts and ideas. They typically concentrate well and are not easily distracted. The extrovert gains energy by spending time with others; the introvert gains energy by spending time alone. Thus, introverts often withdraw from social situations.
These are not the qualities that get a person noticed. They are not the characteristics Americans tend to associate with success. Americans admire and respect the type of people who can walk into a situation and take charge without batting an eyelash. They look up to people who appear steady and confident. In America, the qualities of the extrovert are seen as favorable and are therefore advantageous.
In addition, there is an abundant body of evidence suggesting that extroverts tend to be significantly happier than introverts. So many studies, in fact, have demonstrated this effect that Lucas, Le, and Dyrenforth call the correlation between extroversion and positive emotion "one of the most robust findings in the study of personality and emotion." There have even been studies showing that introverts can increase their positive emotion by acting like extroverts.
And so being an introvert can be difficult. We're systematically undervalued and frequently misunderstood. Often, we're encouraged to become more extroverted, implying that there's something wrong with the way we are. I've seen the impact this can have on people. Over the years, I've had many introverted patients who came to me thinking there was something wrong with them. Such is the plight of the introvert living in an extrovert's world.
I briefly saw a psychologist when I was in graduate school. One of the first things he did was have me complete the Myers-Briggs (a personality assessment). I remember when we went over the results together. "So do you think you're an introvert or an extrovert?" he asked before revealing what the assessment showed. "I don't know," I replied. "I could see it going either way." "Actually," he said, pausing. "You're pretty strongly introverted." "Really?" I asked, surprised. I'd always thought of introverts as being shy, reserved, and quiet -- all things I definately am not. (As it turns out, this is a common misconception).
Discovering I'm an introvert shed new light on a light of things I didn't understand about myself. Once I understood these things about myself I was able to embrace them. I was also more sensitive to what I needed -- plenty of alone time to think and reflect as well as quiet time to regroup after socializing. Whenever I have a patient who is clearly introverted, I set aside time to help them understand what this means. I normalize their need for alone time; I explain that making time to be alone is an essential part of taking care of themselves. Hopefully, they will learn to embrace who they are...
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